I just want to give you a big hug @May22 .
People who use illicit substances don't do it for the sake of doing it. Just like you have shared, there's a reason for the use. It doesn't make you a "bad" or "weak" person. There is much sorrow underneath it.
Real therapists see through to the real person.
In the past, when people saw my BPD diagnosis, they dismissed me as "attention seeking" and pretty much said to get on with life and get back to work. Yet it took 1 therapist to see through this diagnosis and helped me find my identity.
Often, people who have BPD lack self-identity. Their actions are pretty much reliant on their environment. When the environment is "good", they are "good". When the environment is "bad", they are "bad". This is what sets BPD apart from other MH conditions - it is heavily reliant on environmental factors rather than human chemistry, this making medication of limited effect.
Dont get me wrong, medication has its place. My BPD caused me to spiral down into a major depression which means I needed anti-depressants to raise me to a point so that I could comprehend the therapy I was receiving. I also took anxiety meds to help with my anxiety in social situations as well as to help me sleep. So yes, meds have their place, but they do NOT cure BPD. BPD recovery is about changing how we think (or our thinking processes) within our environment so that our actions move from being harmful (eg rage, SH) to being helpful.
So yes, from what I see, your therapy would be more effective if it focused on the core of the issue (emotional regulation) rather than the act of SH.
I hope you find this somewhat helpful.
Look forward to hearing from you. Once again, I applaud your bravery in being so honest in your posts.
BPDSurvivor